蛛网膜下腔与硬膜外联合阻滞用于分娩镇痛的安全性探讨

目的：蛛网膜下腔－硬膜外联合阻滞用于分娩过程的镇痛效果及安全性。方法：随机选取55例自愿要求无痛分娩的产妇，实施蛛网膜下腔与硬膜外联合阻滞，采用罗哌卡因加芬太尼，并与同期55例未实施麻醉的产妇进行比较，观察两组的生命体征，镇痛评分，下肢运动评分，分娩方式，胎儿内窘迫发生率，新生儿Apgar评分、产后出血量及并发症等。结果：镇痛前后产妇生命体征稳定，镇痛痛组取得良好的镇痛效果，与对照组相比，胎儿宫内窘迫发生率显降低（P＜0．05）。分娩方式，新生儿Apgar评分及并发症两且差异无显性。活跃期与第一产程延长，产后2h出血量增多（P＜0．05），但所有数据均在正常范围内，结论：蛛网膜下腔与硬膜外联合阻滞镇痛效果好，罗哌卡因浓度，剂量，给药时机与停药时间有待进一步研究探讨。

Exploration of the safety of combined subarachnoid and epidural in labor

Objective:To investigate the pain relief effect and safety of combined subarachnoid and epidural during labor.Methods:55 cases of pregnant woman volunteers were randomly administered,combined with subarachnoid and epidural with ropivacaine+fentangl,compared with another 55 control pregnant women who did not receive the combined anesthesi. The vital signs,score of analgesia,motor ability of lower extremities,birth process,the incidence of fetal distress,the manner of delivery,the neonatal Apgar's score,the volumes of postpartum hemorrhage and complication were observed.Results:The vital signs in tow groups were stable.Good effect of analgesia was obtained in the anesthesia group. The incidence of fetal distress was decreased significantly(P<0.05),compared with the control group. There was no difference in the manner of delivery,the neonatal Apgar's score and complication between tow groups. but the volumes of postpartum hemorrhage was increased and the 1st stage of labal was prolonged significantly(P<0.05). But all the data are in narmal range.Conclusion:Combined subarachnoid and epidural can produce effective analgesia,but the proper concerntration and dosege of ropivacaine,the dose interval time needs further study.